Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved. A New Vision for the EHR...
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Transcript of Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved. A New Vision for the EHR...
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.
A New Vision for the EHR
Sam Brandt, MD
Chief Medical Informatics Officer
Siemens Health Solutions
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 2
How Tall is K2?
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 3
How Tall is K2?
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 4
What Toxin is in the Skin of Poison Dart Frogs?
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 5
What Toxin is in the Skin of Poison Dart Frogs?
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 6
A pet store employee presents in the ER with rapid onset of confusion, hypotension, and decreased respiratory rate??
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 7
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 8
The Place for Calculators in 1974?
ProsFaster
Easier to use
More significant places
Eliminates decimal point transposition errors
ConsRequires electricity
Floating point errors
Fosters “Laziness”
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 9
The Place for EHR’s in 2009?
ProsFaster & remote access to information
Easier to find data
Helps avoid double entry
Can help with billing
ConsRequires electricity
Less portable
Doesn’t allow random data entry
? Fosters laziness
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 10
But….We Didn’t Stop with Calculators!
Spreadsheet programs allowed for “modeling” of financial data, with “what if” scenarios
Word processors eliminated retyping for corrections, and added spell checking
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 11
And then…We Pushed the Envelope
Computers opened new possibilitiesExpressing complexity
Simulating scenarios
Exploration and recognition
Solving exhaustive computions
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 12
So…How Will EHR’s Push the Envelope?
Changing delivery system models
Point of care decision support
Personalized medicine – Genomics/Proteomics
Patient-centric delivery models
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 13
Mar 5, 2009 7:45 pm US/Eastern
Obama: Healthcare At 'Thelma And Louise' MomentPresident Borrows Dire Movie Metaphor To Describe U.S. System As Heading Toward Cliff CBS News Interactive: Healthwatch
Obama said the participants - doctors, lawmakers, insurers, even skeptics - were universal in agreement that the need for health care reform "is here and now."
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 14
Impacts
Bundled payments for hospitals and providers
Efficacy standards imposed with controls on utilization variance
Emphasis on healthcare delegation to most cost-effective venues with incentive alignments
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 15
Impacts EHR Contributions
Bundled payments for hospitals and providers
Efficacy standards imposed with controls on utilization variance
Emphasis on healthcare delegation to most cost-effective venues with incentive alignments
Increased connectivity supports “Virtual” delivery systems
Point of care decision support
Enterprise research scheduling and process management
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 16
Genomics & Personalized Medicine
Numerous Genotype/Phenotype correlation efforts Potentially thousands of significant variants
Genome sequencing for $100 within 5 years
Rising expectations for preemptive intervention
Physicians will need to consider all diagnostic and therapeutic decisions in the light of the patient’s gene sequence
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 17
A Polymorphism* in the 5' Flanking Region of the CD14 Gene Is Associated with Circulating Soluble CD14 Levels and with Total Serum Immunoglobulin E Mauro Baldini, et alAm. J. Respir. Cell Mol. Biol., Volume 20, Number 5, May, 1999 976-983 TGF-β1 gene polymorphisms
D. Bučkova et alVolume 56 Issue 12, Pages 1236 – 1237Published Online: 20 Dec 2001 Gene polymorphism in Netherton
and common atopic disease
Andrew J. Walley1 et alNature Genetics 29, 175 - 178 (2001) Published online: 4 September 2001; | doi:10.1038/ng728
Managing the Avalanche of Genomic Information
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 18
EHR and Personalized Medicine
PatientInformation
ClinicalKnowledge
PatientCategorization
Indications/Contraindications
Dx/TxSelection
VarianceDB
GeneSequence
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 19
Patient-Centric Delivery Models
Coordinates care across delivery systemSchedules
Tracks
Intervenes
Workflow orchestration
Dx/TxSelections
PatientProcessesPatient
ProcessesPatientProcessesPatient
Processes
Cross-processoptimization
(patient & resource)
Patient-centricProcess
Sequence
Workflow engine Simulation optimizer
Copyright © 2007 Siemens Medical Solutions USA, Inc. All rights reserved.Page 20
The Place for EHRs
2009Brings valuable benefits compared with the limitations of paper charts
2011 and beyondProvides the needed framework for
Changing delivery system models
Point of care decision support
Personalized medicine – Genomics/Proteomics
Patient-centric delivery models